Low molecular weight heparins – should treatment doses be used in patients with renal impairment?

· South West Medicines Information and Training

Randomised controlled trials evaluating LMWH efficacy and safety have generally excluded patients with severe renal impairment (RI). In contrast to UFH, LMWHs are primarily cleared via renal excretion. Therefore, care is required if LMWHs are given to patients with RI because they can accumulate and increase the risk of bleeding. Patients with chronic RI are challenging since they are at an increased risk of both thrombosis and bleeding. This Q & A reviews the current literature regarding the use of treatment doses of LMWHs in patients with RI.